Refused a smear but worried about symptoms.

[LuSmithTheMyth]

Hey there, new to these forums but haven't got any answers anywhere else and I've noticed these forums are quite active so maybe here I'll have more luck.

I just had my baby ten weeks and a half ago. I had a normal vaginal delivery and no problems with bleeding during pregnancy, just severe abdominal cramping from time to time during last trimester. My bleeding was heavy for the first few weeks and tailed off after four weeks, returning as light pink spotting two weeks after which didn't go until I had a seven and a half week check in which I was given the depo provera jab. My bleeding cleared for two weeks but I still had yellowy discharge, however in the last week spotting has returned. It smells a little too and I have lower back pain, pelvic pain and tenderness and bowel problems. I asked at my seven and a half week check for a smear test and she refused saying that they wouldn't look at it. I'm 27 and had my first two years ago which came back negative (normal). I'm due one next November. My symptoms are concerning me as they seem to all point to the big C. I don't know if something as Cervical Cancer would progress so fast so soon as I've never had abnormal bleeding before but I've had a yellow odorous discharge for as long as I can remember (since I was sexually active perhaps). Around the time of my first smear I had a full STD check which all came back normal (also 2 years ago or so).

I know abnormal bleeding doesn't necesarily point to such a worrysome thing, and that maybe it's been triggered by depo provera again or a hormonal imbalance, even cervical errosion perhaps, but I would feel better knowing a smear test result, then any abnormal result could be looked into. Should I bypass and find somewhere that would give a colposcopy? I asked to be referred three times to a gyne and got the same answer - no need.

I have an ultrasound (only external) on the 2nd Jan, which I'm worried might not pick anything up. I have no other means of investigation going on.

I've considered a private smear if I'm refused again but I don't know where to go for one as I live in South Kent. (UK)

Advice?

Hi,
your symptoms sound really similar to mine after DS1. Turned out I had a piece of placenta retained. If this is the case it should be picked up on ultrasound (although my scan was arranged within a few days of being requested by GP). I had a D&C under GA to remove it same day as diagnosed by scan. NHS.

I guess I should hold on to that fact but I know that I had my first sexual partner aged 17 so it's already 10 years now! Would that put me at risk or is the fact I had a smear that came back okay 2 years ago probably an indicator that its doubtful I have anything serious? I guess I should try to hold on to the fact that I doubt any cancerous cells would develop into full blown problems that quickly. Isn't it 10-15 years from the cells starting to change?? I hope so haha! I'm just a bit paranoid that they missed something last time or that because I've been sexually active since I was 17 and am 27 now that I would be at risk!

Oh I have been on that forum, they are wonderful! x

Sorry, that last message was in response to Naomii :)

Thanks for all the advice and stuff so far ladies, you've definitely made me feel better, and Zipity - I definitely know how anxiety after having a baby feels! I've suffered anxiety for years and seriously thought I'd be okay as I was alright during the pregnancy but unfortunately my depression and anxiety hit full force because of my health concerns!

Thanks sayjay, perhaps it is placenta that needs to be removed.. they dont seem to think it's urgent though as she didn't refer me urgently so I've only got my scan on the 2nd Jan but hopefully I'm fine.. did you get to go home same day after having D&C? I know it's an outpatient thing I think!?

"Naomii Thu 22-Dec-11 11:43:11

Just a tiny point, catsraeevil and Bela - smear tests are done if a woman is symptomatic but the cervical screening programme is a separate entity, i.e if you go to your GP with abnormal bleeding they will do a smear regardless of when you last had one done under the screening programme."

Naomii I work in the screening programme in a screening lab and I can tell you that GPs are not supposed to do a smear if you go to them with abnormal bleeding because a cervical smear is unlikely give the reason for it.
I did link to the guidelines about investigating abnormal bleeding (tho' its more about younger women). As you are a practice nurse I'm a bit surprised that your local lab hasn't been on the phone asking why you're taking cervical samples on women with symptoms - unless these are women who are due for a test anyway?

LuSmith - this is really difficult to get across in writing on the internet but many women think that doing a cervical smear test with symptoms such as yours will be helpful.
It is unlikely to be abnormal cervical cells causing the bleeding so doing a screening test isn't a very good idea. At worst if taken it could be falsely reassuring if it comes back negative. I have seen cases where women who had symptoms had a smear done and nothing else, not even a swab because the smear test was negative.
Your GP doesn't sound very helpful or understanding either, is there another one at the practice that you could see? You could also try either a FPC or GU clinic as they will also used to be investigating problems with contraception and infections. It is good that you've been referred for a scan but if it is retained placenta tissue then it could really do with being removed asap. Personally I would press to be seen for the scan quicker and may be either seeing a different GP or ringing up to see when the scan is scheduled for and explaining your symptoms would help.

The reason screening labs ask not have a cervical samples from post natal women is because they're more difficult to read.
The more abnormal cells are quite small and immature, because the process of becoming abnormal means they ignore the body's normal signals including hormones. Normal cervical cells and epithelium mature under the influence of oestrogen. In the post-natal state the oestrogen levels are low, plus there can be inflammation and reactive change due to the birthing process.
These normal post-natal changes can end up mimicking abnormal cells - so we'd rather wait and read a sample from when the hormone levels are back to normal to avoid reporting a sample as abnormal and possibly sending someone for investigation unnecessarily.
HTH :)

Hi Lu - yes. I was phoned by gynae ward the day after GP referral (I think) asking me to come for scan - they had bed for me on a ward and everything, which made me a bit confused - thought I was going for scan, then home!
Anyway 4cm piece of placenta seen. Offered place on emergency list that afternoon - although warned I wasn't "true" emergency so if, say, a woman was haemorrhaging I would get bumped off. I was pencilled into a slot on the following Mon (this was Fri) in case that happened.
I actually had it done in the evening - about 8pm iirc - and insisted on being discharged at midnight rather than stay in. I was bf'ing 9week old DS and me,DH and DS had been there since 10am expecting an in and out. I just wanted to get home!

My symptoms had been: bleed for 2 weeks, stop for 2 weeks, bleed for 2 weeks (offensive smell towards end of these 2 weeks) - 6 week check with gp, 2x courses of antibiotics - continued bleeding, but less smelly, then referral. Bled for about a week after D&C. Sorry if TMI

all the best, hope you are seen soon and well looked after x

Bela- I guess that makes sense. I just wonder because of the pain I'm having whether its something which should be seen to rather than brushed aside. because my doctor didn't list the problem as urgent my ultrasound isn't until the 2nd and she said because I'm not with fever or pouring with blood then its not an urgent matter. I disagree tho, its my body and I hate these symptoms. :(

Sayjay- ah where you are they must be really good haha. did the d&c hurt? Did you have soreness afterward and was out under general anasthetic...? I really would be daunted but I guess they do what has to be done! I just wish my doctor had taken me more seriously.. Suffering until the 2nd is not my ideal christmas! x

She has got you an ultrasound 10 days from now and a gynae referral. It might not be as quick as you would have liked, but given the time of year and the nuber of public holidays at this time, its not too far away.

The symptoms that you have arent that uncommon in people who have recently given birth, so hopefully they will start to lessen over the next few weeks.

i think your GP is right not to give smear. The changes are its very likely all pregnancy related. You sound like me after my second. I was bleeding for weeks and ended up with an infection :( It was painful and i felt yuck, but as soon as the infection had gone i felt much better.
Try not to panic

Hi Bela, no don't worry, I'm not breaking the rules! Was just making the point that cervical sampling is sometimes part of the workup if a woman has symptoms and is due a smear/is outside the programme and was also trying to say that the screening programme is not intended to be diagnostic but obv didn't make it very clear! Sorry! :)

Zipity and Lu, I hope you both have a very special christmas with your new little ones, sometimes it really helps to try and distract yourself from anxious thoughts as much as you can, and not fight them too much, just let them flow into your head and back out again and don't focus on them, say 'oh hello anxious thought, there you are and off you go' - it does work! xx

"Sayjay- ...did the d&c hurt? Did you have soreness afterward and was out under general anasthetic...? ... Suffering until the 2nd is not my ideal christmas! x"

No pain AT ALL. Yes, GA. Tiny bit woosy next day, that was all. If you really feel you can't wait due to your symptoms, you may get an ultrasound through a&e.........

Either way - enjoy your little one's first christmas! x

Thanks guys.. perhaps my problems are all childbirth related/hormone related, who knows?? I've noticed though that my constipation is quite bad and it doesnt help that I've got hemmorhoids! Hopefully it's not a rectocele or something because I get achey feelings in my vagina too, though it doesn't feel like there's anything in there or a bulge so i don't know.. just feels achey and I get lower back pain and cocyx pain, rectal pain and leg aches. I know this is probably all associated with constipation so it could be that my pelvic floor is messed up (PFD???) or something, not sure.. but I do feel that pressure when I try to make a BM and constant feeling of needing to evacuate, even when I've gone.

If they do find something they will probably only do anything if it's urgent I guess, but I've heard alot of people do okay under GA so if I were to have a D&C I'll just go through with it haha. I guess it's all better to get sorted! It sucks having all this pain til the 2nd but what can you do...

Thanks Naomii btw, hope your Christmas is lovely :) I'm trying to concentrate on other things, quite hard with the pain sometimes! But doing my best!

Hi
If the pain is strong enough to make it difficult to concentrate, is it keeping you awake as well (prob tricky to tell with a new LO!)?
Have you been taking any painkillers as they can also cause constipation.
Personally I wouldn't want to wait until the 2nd - is there an NHS walk in centre nearby. The main thing is to get some further investigation going (I appreciate you have got the scan lined up for them) and don't be fobbed off by the doctor. A smear test shouldn't play a part in diagnosing illness when someone has symptoms as it's such a blunt instrument. There's lots that it won't tell you IYSWIM?

I hope you can relax and have an enjoyable Christmas and fingers crossed you can get some help soon.

It does keep me awake sometimes, but then I get woken up alot by colickly LO and find it majorly difficult settling him and then getting settled myself so lack of sleep plays a factor in stress too.
I only take paracetamol to ease the pain - no other pain killers as I'm avoiding getting too constipated!
I don't really want to myself but there's no walk in clinic anywhere near here and I don't want to spoil Christmas for my family by going all the way to the hospital as I've been so stressed out about it I'm sure they're sick of hearing about it! I know a smear test probably won't rule out other problems and I'm really hoping it is just a depo injection or hormonal thing thats contributing to the bleeding instead of anything serious. I imagine it probably isn't anything serious as thats very rare but my stupid hypochondriac mind keeps thinking otherwise!

Having been ill myself I do understand not wanting to bother anyone, and the weird ambivalence oscillating between "its nothing serious" and "what's going on".
I had been back to the GPs a few times until I saw one who "got it" and then the right investigations were started.
I guess my opinion is whatever you feel comfortable with re the date for the scan but please do feel that you're 'worth' the time and trouble to get proper care and investigations and don't give up.

Thanks hun that's really nice of you. I do hope that you don't think that I have anything to be concerned about? I'm slightly worried that you're saying if I leave it I may be in a horrible situation...? I know that things have to be investigated if just to put my mind at rest and know what its about but I really don't want to fear anything bad anymore, I wanna put my thoughts aside from that as it's damaging my mental health! :(

PS I've just seen the other threads you've started and I had some similar symptoms to you (I'm not saying that's what you've got!).
I had a 20cm ovarian cyst, endometriosis and adenomyosis - terrible constipation but not sure whether that was due to the cyst, endometriosis, painkillers or all three.
I put off going back to the GP for ages because they'd thought the problems were due to my existing back issue and I was in denial that there was a problem. It was such a relief when this GP said she could feel something and I needed referring. Given that my work area is dealing with cervical screening and gynae cancers it shows that someone who is well informed can still feel wierd about this sort of thing. :)

Well if my case is a helpful illustration i.e. not scientific just one person's ancedote, what I had was benign. I can't say whether what's causing your problems is "bad" or not, just wanted to help you feel that it's ok to want to have some answers, does that make sense? :)

Yeah I thought of endometriosis - I mentioned that to the doctor and she gave me a hard time regarding it because she thought I was "googling" again. How did they sort your problems out? I'm guessing the US will show anything like that should there be anything!

And thanks :) I guess I know I shouldn't feel bad to want answers, I just don't want to feel scared constantly that's all. I guess that seeing as I'm still young, supposedly healthy and didn't have these kind of problems til my third trimester (August this year) that its doubtful it could be anything too serious! I just gotta keep my mind on that and hope that whatever it is (if anything) can be easily sorted - I hope it's just simple constipation and hormonal stuff!